What you should know about avoiding pelvic floor issues from bad form.
“Engage your pelvic floor,” is a common refrain in Pilates classes around the globe, but even if you’re a studio rat, you may be fuzzy on what it means. Your pelvic floor muscles play significant roles in your body’s functioning, but they’re difficult to pinpoint if you’ve never learned how to activate them.
It’s important to get to know these muscles — and, yes, how to engage them — especially if you like to lift heavy weights. Find out why improper weightlifting can be problematic to pelvic floor health, how to avoid issues.
The Function of the Pelvic Floor
Your pelvic floor is a set of 14 muscles that form a sling at the base of your pelvis.
“If you think of your abdomen like a balloon, your diaphragm (the biggest breathing muscle) is the apex of the balloon, your deep core muscles (your abs, side and back muscles) are the mid section of the balloon, and the pelvic floor muscles are the base of the balloon,” explains Sneha Gazi, DPT, a New York-based physical therapist.
Your pelvic floor muscles provide support to your pelvic organs (e.g. your bladder) to help keep them in place. They also allow you to urinate and defecate properly, as relaxing the muscles lets you release waste.
“When there is an imbalance with these muscles, or when they are not used in sync, over time it can lead to strain,” says Gazi. It’s as if the “balloon” in this analogy is unable to properly withstand the air that’s pumped into it.
Weakened pelvic floor muscles can contribute to an issue called pelvic organ prolapse, when the muscles no longer provide adequate support and a pelvic organ(s) drops from its normal position. A weak pelvic floor can also lead to urinary or fecal incontinence, due to the muscles’ role in controlling the release of waste. While pelvic floor disorders are more common in people with female anatomy (especially those who give birth vaginally), they can affect anyone.
How Lifting Affects Your Pelvic Floor
Often, health professionals advise people with pelvic floor issues to avoid lifting heavy weights. While that recommendation may sound counterintuitive — the point of lifting is to strengthen your muscles, after all — it has basis.
“Lifting heavy weights and high impact activities put strain on the muscles of the pelvic floor,” says Or Artzi, a pre/post natal specialist Equinox trainer at multiple New York-area clubs. “The heavier the weight or the higher the impact, the more pressure applied on those muscles that are working hard to support your organs.”
If you’re lifting more weight than you can handle, and/or failing to properly engage your pelvic floor, this can create issues. “The pelvic floor muscles have to work harder when there is excessive intra-abdominal pressure exerted within the abdominal cavity due to improper heavy lifting,” explains Gazi.
The effects of weightlifting on pelvic floor health are still somewhat unclear. “It’s important to note that there is not a lot of research on weightlifting and pelvic floor dysfunction, and the studies that exist are not always of high quality or applicable to the general population,” says Gazi.
For example, while one 2020 study found a high prevalence of pelvic function disorders in powerlifters and Olympic lifters, another study from this year found that when pregnant recreational athletes lifted heavy, it didn’t affect their pelvic floor health compared to those who avoided lifting.
In other words, heavy lifting may be problematic for some populations but not others, says Gazi. “This could be due to the duration that the person trains and the amount that they are actually lifting,” she says. “In fact, weight training in general can be beneficial in treating some types of pelvic floor dysfunction, like urinary incontinence in elderly women.”
It’s tough to say whether heavy lifting can create a pelvic floor issue or just exacerbate an existing one, says Gazi. “I think both can be true, but the risk of having pelvic floor dysfunction increases when lifting is combined with other risk factors,” she says. “At the end of the day, if there is too much load to the muscles and not enough pressure management then a new problem can begin, or an existing problem could get worse.”
How to Safely Reap the Benefits of Lifting
The takeaway here isn’t that you should give up lifting. Quite the opposite, as it boosts your strength and coordination, can make you more confident, and may reduce your risk of some chronic diseases.
Instead, focus on taking measures to lower your risk of negative effects. If you have an existing pelvic floor issue, it’s best to meet with a physical therapist who specializes in pelvic floor health. They can give you personalized guidance on how to safely approach exercise.
Even if you don’t have an existing issue, you want to avoid vanity lifting, instead reaching for weights that you can move with proper form. It’s also imperative that you learn how to properly engage your core when lifting. Here’s how, according to Artzi:
1. Find a neutral alignment in spine with ribs stacked over pelvis, neck long, and shoulders relaxed.
2. Keeping shoulders relaxed, inhale through nose, sending the air into rib cage so that rib cage expands in all directions.
3. Exhale through pursed lips while drawing navel in and pelvic floor muscles together.
Once this becomes natural, you can incorporate the technique during exercises. You should exhale and contract your pelvic floor during effort (e.g. while pressing a barbell up on a bench press or coming up from a squat) and inhale during the opposite motion.
You might also consider supplementing your weight training sessions with workouts that place an emphasis on building pelvic floor strength, like Pilates.
Daily Kegel exercises can also help you maintain a strong pelvic floor that’s better able to withstand the strain of heavy lifting.
To take advantage, Artzi recommends completing the above breathing exercise, focusing on contracting the muscles you’d use to stop the flow of urine and those you’d use to stop yourself from passing gas, and bringing your sitz bones together with each exhale. (Your sitz bones are the bones you feel when sitting on your hands.)
Then, try repetitions of the same contraction and release of your pelvic floor, this time at a faster tempo. With this exercise, you should aim to contract and release over the span of one to two seconds, and breathe naturally rather than timing your inhale and exhale to the contractions.
To summarize, you should take measures to keep your pelvic floor healthy, but should feel free to lift weights in a way that’s safe for you.
“There is a risk in everything you do, but I am a firm believer that there is more risk in not lifting weights than lifting,” says Artzi. “Lifting heavy weights will get you stronger, make you leaner as it increases your resting metabolism, will improve coordination, and will make you feel fierce.”